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Awarded Grants

Grants Awarded in 2014

Validation of candidate rosacea genes by targeted interrogation of alleles and assessment of rosacea co-morbidities.
Dr. Anne Chang, assistant professor of dermatology at Stanford University School of Medicine

Dr. Chang was awarded $17,554 to begin to identify rosacea genes using a methodology called a genome-wide association study. A genome is an organism’s complete set of DNA, including all of its genes. Each genome contains all of the information needed to build and maintain that organism. In humans, a copy of the entire genome – more than 3 billion base pairs – is contained in all cells that have a nucleus. If genetic coding specific to rosacea is found, individuals at risk may be identified through a blood test so that early intervention and avoidance of triggers may be possible. This finding may also provide a better basis for further study and future therapy or potential prevention.

Dr. Chang noted that five possible gene locations are linked to genes associated with human inflammatory conditions, including diabetes, inflammatory bowel disease, multiple sclerosis and sarcoidosis. Researchers will evaluate whether there is increased prevalence of these conditions in individuals with rosacea.

Status: Study beginning.

Mast cells in rosacea: the neurological connection.
Dr. Anna Di Nardo, associate professor of medicine at the University of California-San Diego

Dr. Di Nardo was awarded $25,000 to study whether there are further indicators that mast cells (MCs) are a dermal translator of inflammatory signals from the epidermis. In this study, Dr. Di Nardo will note whether injection of a nerve blocker into both mice and humans will block the activity of a neuropeptide that activates inflammation in mice, and whether it may reduce redness in people. Results will be assessed by digital photography, clinical grading scales and colorimetry, a device that quantifies and describes color. In addition, they will evaluate whether enzyme levels that are altered in individuals with the inflammation of rosacea are normalized.

Status: Study beginning.

Genetic basis of skin diseases in twin pairs and their families.
Dr. Daniel Popkin, assistant professor of dermatology at Case Western Reserve University

Dr. Popkin was awarded $25,000 to study the facial microbiomes – the unique community of microorganisms that resides in all individuals – of identical twins in whom only one has rosacea. In earlier work, the researchers studied the contribution of genetics versus the environment in identical and fraternal twins. They noted that studying rosacea in identical twins makes it easier to discover how specific factors such as bacteria affect its development without being potentially misled by the many genetic factors that may contribute to it, and this knowledge may lead to more accurate diagnoses and more targeted treatments.

Status: Study beginning.

Grants Awarded in 2013

The role of mast cells in rosacea inflammation: a new treatment
Dr. Anna Di Nardo, associate professor of medicine at the University of California-San Diego

Dr. Anna Di Nardo and her research team were awarded $25,000 to continue research on the role of mast cells in rosacea inflammation. This study aims to determine whether use of the mast cell stabilizer known as topical cromolyn sodium will decrease symptoms associated with rosacea. The study will also examine the normalizing effects of the stabilizer on levels of enzymes that are typically higher in rosacea patients.

Status: Interim report received. Study continues.

A novel therapeutic approach via modulation of sphingolipid signaling in rosacea
Dr. Yoshikazu Uchida, research dermatologist, and Dr. Peter Elias, professor of dermatology at the University of California-San Francisco

Dr. Uchida and Dr. Elias were awarded $25,000 for further study of a biochemical pathway that may lead to inflammation. In previous NRS-funded research, Dr. Uchida identified that such triggers as sunlight and irritated skin may stress the endoplasmic reticulum, a membrane involved in sorting proteins. In the new research, the investigators will observe the effects of blocking this and other pathways as well as study whether the application of topical substances known as resveratrol and fatty acid derivative blocks inflammation on skin with rosacea.

Status: Interim report received. Study continues.

Grants Awarded in 2012

The role of mast cells in rosacea inflammation.
Dr. Anna Di Nardo, associate professor of medicine, University of California-San Diego.

Dr. Di Nardo was awarded $25,000 to study the role of mast cells as a possible link between an overabundance of the antimicrobial peptides called cathelicidins in individuals with rosacea and the inflammation that appears on rosacea skin. Dr. Di Nardo will endeavor to identify inflammation-causing enzymes that are produced by mast cells as well as the influence of neuropeptides on the formation of these key enzymes.

Drs. Gerstenblith and Popkin were awarded $10,000 to study the incidence of rosacea in fraternal and identical twins, recruited at the annual Twins Day festival in Ohio. The study aims to document potential genetic factors by determining if there is a statistically significant difference in the correlation of rosacea between identical and fraternal twins.

Status: Study completed. Final report pending.

Kallikrein protease inhibitors in the pathogenesis of rosacea.
Dr. Ulf Meyer-Hoffert and Dr. Thomas Schwartz of the Department of Dermatology, University Clinic Schleswig-Holstein, Germany.

Drs. Meyer-Hoffert and Schwartz were awarded $20,000 to study whether and how kallikreins, enzymes that contribute to inflammation in rosacea, can activate cytokines, which might contribute to the disease activity. The investigators will also research inhibitors of this substance that could have the potential to treat the disease.

Status: Interim report received. Study continues.

Analysis of the skin microbiome in rosacea.
Dr. Barbara Summerer, postdoctoral research fellow in dermatology, Johns Hopkins University School of Medicine.

Dr. Summerer was awarded $25,000 to use sophisticated analytical technology to evaluate specific microbes in rosacea patients. She will further use epifluorescence microscopy to identify possible biofilms – communities of bacteria that adhere to surfaces – that may exist in rosacea patients, as well as the differences in types of bacteria present in subtype 1 (erythematotelangiectatic) rosacea and subtype 2 (papulopustular) rosacea, so that therapy can target these bacteria.

Status: Interim report received. Study continues.

Regulation of antimicrobial defense and suppression of inflammation via modulation of sphingolipid signaling in rosacea.
Dr. Yoshikazu Uchida, associate research dermatologist, and Dr. Peter Elias, professor of dermatology, University of California-San Francisco.

Dr. Uchida and Dr. Elias were awarded $20,000 to study whether and how enhancing the production of human β-defensin 2 and conversely suppressing the production of cathelicidin antimicrobial peptide, part of the body’s innate immune system, may help suppress the excess of inflammation-causing peptides found in rosacea skin.

Status: Study completed. Read final report.

Grants Awarded in 2011

Functional role of PACAP and its receptors in neurovascular aspects of rosacea.
Dr. Ferda Cevikbas, postdoctoral fellow, and Dr. Martin Steinhoff, professor of dermatology, University of California-San Francisco.

Dr. Cevikbas and Dr. Steinhoff were awarded $25,000 to assess the role of PACAP, a neuropeptide that may affect rosacea. They plan to define the distribution of PACAP in skin samples from rosacea patients, determine whether PACAP induces inflammation and test whether cathelicidin — a known factor in rosacea's pathophysiology — modulates the release of PACAP. The researchers also plan to test whether countering the effects of PACAP is beneficial and may thus be used as a rosacea therapy.

Dr. Wladis was awarded $12,100 to identify specific cytokines — molecules that regulate the immune system — that are involved in ocular rosacea by studying eyelid tissue from individuals with and without the disorder. Dr. Wladis noted that while inflammation is normally a healthy part of the immune response, aberrations in the cytokines' concentrations and functioning in rosacea may result in unhealthy and prolonged inflammation.

This knowledge may have significant therapeutic implications for ocular rosacea, as medications have been designed to suppress specific cytokines. Dr. Wladis will also investigate the role of toll-like receptors (TLRs) — proteins that identify invading agents and alert the innate immune system to begin protective reactions.

Dr. Granstein and colleagues were awarded $25,000 to study the potential role of Th17 cells, a newly discovered class of cells that appear to be involved in a number of inflammatory and autoimmune disorders. Earlier study results strongly indicated that release of ATP — a neurotransmitter and carrier of chemical energy throughout the body — from nerves under stressful situations may initiate a sequence of events leading to or exacerbating inflammation in the skin. This study will investigate whether this inflammation results because Th17 cells are produced during this process in rosacea.

Dr. Feramisco and Dr. Steinhoff were awarded $25,000 for their study. The researchers hypothesize that, based on earlier studies, the flushing, bumps and pimples of rosacea may be the result of a dysfunctional regulation in the neurovascular system, with subsequent vascular and chronic inflammatory reactions.

Their study has four aims, they noted: to establish a relationship between certain sensory nerves and immune cells in different subtypes of rosacea; to genetically characterize crucial components of the neurovascular network with regard to disease stage, gender, age and the presence or absence of Demodex mites; to investigate the role of specific temperature and irritant receptors as neurovascular regulators in mice; and to identify families suffering rom rosacea with prominent trigger factor-induced flushing/redness and isolate their DNA for analysis.

Dr. Wilson and colleagues were awarded $25,000 for their study. The researchers noted that events triggering flare-ups such as emotional stress and hot or cold weather are associated with fight-or-flight stressors that increase nervous activity to the skin, including skin blood flow regulation and skin gland secretions. The researchers plan to compare this nerve activity in the facial skin of rosacea patients with control areas such as leg skin.

Using microneurography, they will quantify the nerve activity during three trigger events, including mental stress, physical stress and thermal stress. If facial nerve activity is found to be higher in individuals with rosacea, therapies may then be developed to decrease symptoms and possibly prevent disease progression.

Evaluation of the effect antibiotics used in the management of rosacea have on the immortalized human sebocyte cell line (SZ95) -- in vitro studies.
Dr. Noreen Lacey, postdoctoral researcher, and Dr. Siona Ni Raghallaigh, research fellow, University College Dublin Clinical Research Centre and Mater Misericordiae University Hospital in Dublin, Ireland.

Dr. Lacey and Dr. Raghallaigh were awarded $25,000 for their study. The researchers noted that although the effectiveness of oral antibiotics is believed to be due to their anti-inflammatory properties rather than from destroying bacteria, more powerful anti-inflammatory drugs are ineffective and may even make the condition worse.

Because patients with dry, sensitive skin often report less irritation and dryness after antibiotic treatment, the investigators analyzed the oil on the skin surface before and after treatment with antibiotics and found that abnormalities of the sebum had been altered after treatment. In the new study, the researchers will determine the effect of antibiotics on the production of lipids, as well as properties that may affect rosacea.

Grants Awarded in 2009

The role of plasmacytoid dendritic cells and type 1 interferon production in rosacea.
Dr. Curdin Conrad, senior postdoctoral research fellow, Department of Immunology, MD Anderson Cancer Center, and Dr. Alexander Navarini, senior postdoctoral research fellow, Department of Dermatology, University Hospital of Zurich, Switzerland.

Dr. Conrad and Dr. Navarini were awarded $21,450 for their study. They noted that their work is a logical follow-on to the studies by Dr. Richard Gallo and colleagues, also supported by the NRS, which found that in rosacea, antimicrobial peptides such as cathelicidins are involved. Given that these peptides are part of the innate immune system, their work will examine the next steps in the body's immunological process to see whether type I interferon, glycoproteins that help fight viral infections, and plasmacytoid dendritic cells, which produce interferon, are present in rosacea. They noted that these mechanisms contribute to psoriasis, and a similar finding in rosacea could form a sound basis for newer treatment strategies for rosacea.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, chief of the division of dermatology at the University of California-San Diego, and Dr. Kenshi Yamasaki of the Veterans Medical Research Foundation.

Dr. Gallo and Dr. Yamasaki were awarded $25,000 to continue their NRS-funded research of how cathelicidins may play a role in the development of subtype 2 (papulopustular) rosacea. Past support from the NRS has enabled them to show that people with rosacea have too much of a molecule known as cathelicidin, and using mice and artificial cell culture techniques, they showed that this excess leads to rosacea symptoms. They have also shown that the overabundance of cathelicidin is the result of an excess of an enzyme in the facial skin. In the new study, the researchers will test their hypothesis that the abnormal enzyme is a critical step in the development of rosacea. Too much cathelicidin and too much of this specific class of enzyme may explain its presence, which may in turn suggest a therapy that will inhibit the production or action of these molecules.

The role of tissue kallikreins in rosacea.
Dr. Joseph Rothnagel, associate professor, and Dr. Manuela Trabi, adjunct lecturer, Department of Molecular and Microbial Sciences, The University of Queensland, Australia.

Dr. Rothnagel and Dr. Trabi were awarded $18,000 for their research. This study will build from the work of Dr. Gallo and colleagues. They noted that these previous studies reported involvement of the enzyme hK5 and protein CAP18, and hypothesize that at least one other enzyme is also elevated in rosacea. They will study whether proteins known to be crucial for skin integrity are also digested at a higher than normal rate by these enzymes, allowing easier access for pathogens.

Status: Eligibility expired.

Role of beta-arrestin in cutaneous flushing.
Dr. Robert W. Walters, assistant professor, Division of Dermatology, and Dr. Robert J. Lefkowitz, professor, Department of Medicine, Duke University Medical Center.

Dr. Walters and Dr. Lefkowitz were awarded $25,000. The researchers pointed out that niacin, or vitamin B3, long associated with severe flushing, stimulates receptors on skin cells that react by activating both G and beta-arrestin proteins. However, they noted that a recent study has identified niacin-like drugs that can stimulate only the G protein but do not induce flushing, suggesting that it is the beta-arrestins that may regulate flushing. The results of the new project are intended to lead to better understanding of changes in skin blood flow and possible treatments for this significant symptom of rosacea.

Grants Awarded in 2008

Clinical and molecular analysis of differences between rosacea and photoaging.
Dr. Yolanda Helfrich, assistant professor of dermatology at the University of Michigan.

Dr. Helfrich was awarded $25,000 to compare subtype 1 (erythematotelangiectatic) rosacea and photoaging, both of which may include the development of telangiectasia (visible blood vessels) and erythema (redness). The study will examine the potential differences and similarities of those signs in respective patient groups at a clinical and molecular level, which may increase understanding of the pathogenesis of rosacea as well as lead to improvements in differential diagnosis and treatment.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, chief of the Division of Dermatology at the University of California - San Diego, and Dr. Kenshi Yamasaki of the Veterans Medical Research Foundation.

Dr. Gallo and Dr. Yamasaki were awarded $25,000 to continue their NRS-funded research of how cathelicidins may play a role in the development of subtype 2 (papulopustular) rosacea. In previous study results recently published in Nature Medicine, the researchers found that people with subtype 2 rosacea had abnormally high levels of cathelicidins, as well as an overproduction of anti-inflammatory peptides known as stratum corneum tryptic enzymes (SCTE). They also discovered that the high level of SCTE results in a different form of cathelicidins than found in patients without rosacea. By putting these two observations together, the researchers were able to induce signs of rosacea in the skin of mice, thus suggesting that these molecules play an important role in the papules and pustules of subtype 2 rosacea.

In the new study, they will examine these and related substances at the molecular level and conduct further tests in animal models. They note that successful results will further support the hypothesis that high levels and an abnormal form of cathelicidins lead to rosacea, opening the way for new therapeutic approaches.

Studies in the role of sympathetic neurotransmitters in rosacea.
Dr. Richard Granstein, chairman of dermatology, and Dr. Cynthia Magro, director of dermatopathology, Cornell University.

Dr. Granstein and Dr. Magro were awarded $25,000 to continue their research on the role of adenosine triphosphate (ATP) in recruiting inflammatory cells in subtype 2 (papulopustular) rosacea. The researchers have found that stress, a common rosacea trigger, may activate the sympathetic nervous system with release of ATP from sympathetic nerves innervating cutaneous blood vessels. Earlier NRS-funded studies had shown that ATP initiates an inflammatory response mediated by human dermal endothelial cells. The researchers will also expand their study to examine whether three other agents produced by nerves elicit effects similar to ATP, and will test whether therapeutic agents for rosacea work by inhibiting the expression of inflammation-causing molecules by endothelial cells.

Dysregulation of neurovascular communication in the pathophysiology of rosacea.
Dr. Martin Steinhoff, department of dermatology, University of Muenster, Germany.

Dr. Steinhoff and colleagues were awarded $25,000 to study the role of neuroimmune interactions in the pathophysiology of rosacea. In an article recently published in the Proceedings of the National Academy of Sciences, Dr. Steinhoff and co-workers revealed a new mechanism by which peptidases regulate the cell signaling of neuropeptide receptors, resulting in the control of neurogenic inflammation. In the new study, by molecular, cellular and genomic approaches, the researchers will attempt to characterize the molecules and receptors involved in the abnormal interaction between neuropeptide receptors and neuropeptide-degrading enzymes, which results in dysregulation and contributes to the development of rosacea.

Grants Awarded in 2007

Evaluating the role of angiogenesis in rosacea and ocular rosacea and identifying angiogenic risk.
Dr. Sandra Cremers, department of ophthalmology, Harvard Medical School.

Dr. Cremers was awarded $25,000 for a study evaluating the role of angiogenesis (new blood vessel formation) in ocular rosacea. Dr. Cremers will investigate the levels of angiogenesis markers, such as vascular endothelial growth factor (VEGF), in the conjunctiva and eyelids of patients with severe ocular rosacea, compared with normal subjects. She postulates that defining the role of angiogenesis in the development of ocular rosacea may bring focus to future research on this common rosacea subtype, and eventually lead to the development of an effective treatment.

Status: Interim report received. Study continues.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, chief of the Division of Dermatology at the University of California - San Diego, and Dr. Kenshi Yamasaki of the Veterans Medical Research Foundation.

Dr. Gallo and Dr. Yamasaki were awarded $25,000 to continue their NRS-funded research of how cathelicidins, one of the body's own natural antibiotics, may play a role in the development of rosacea symptoms. The investigators most recently determined that an excess of an enzyme in the facial skin of rosacea patients leads to an accumulation of cathelicidins, an antimicrobial peptide that can cause inflammation and increased blood vessel growth. In a new study, they will be investigating the causes of this enzymatic abnormality and testing whether this enzyme may be a key cause of rosacea.

Dr. Granstein and colleagues were awarded $25,000 to continue their research on the role of adenosine triphosphate (ATP), an agent produced by nerves that earlier NRS-funded studies had shown initiates an inflammatory response in human dermal endothelial cells. The researchers will also expand their study to examine whether three other agents produced by nerves elicit effects similar to ATP, and will test whether therapeutic agents for rosacea work by inhibiting the expression of inflammation-causing molecules by endothelial cells.

Dr. Keyser received $25,000 to study the effects of nicotine on rosacea. Because previous research has shown that nicotine can cause new blood vessels to form in the skin, Dr. Keyser plans to investigate which intracellular signaling pathways are affected and which cellular mechanisms may cause a reaction in rosacea. In addition, Dr. Keyser will examine the short- and long-term effects of nicotine on gene expression and transcription as they may relate to the development of rosacea.

Status: Interim report received. Study continues.

Role of neurovascular interactions in the pathophysiology of rosacea.
Dr. Martin Steinhoff, department of dermatology, University of Muenster, Germany.

Dr. Steinhoff and colleagues were awarded $25,000 to study the role of neuroimmune interactions in the pathophysiology of rosacea. In previous NRS-funded studies, Dr. Steinhoff's team found that neuropeptide-positive sensory nerves around blood vessels increase during rosacea's development. In addition, they discovered that a combination of several neuropeptides, neuropeptide receptors and endopeptidases is involved in maintaining homeostasis, but this balance is compromised in rosacea skin. In the new study, the researchers will examine whether the ineffective interaction between neuropeptide receptors and neuropeptide-degrading enzymes results in dysregulation and contributes to the development of rosacea.

Grants Awarded in 2006

Studies on the role of P2 receptors in rosacea.
Dr. Richard Granstein, chairman of dermatology at Cornell University.

In past research, Dr. Granstein and colleagues found that substances that activate endothelial cells through the P2 cell receptors cause the release of factors that recruit and promote inflammation. They will receive $25,000 to study which P2 receptors are affected, and whether inhibiting these substances in vitro may facilitate the discovery of new treatments for rosacea.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, chief of the division of dermatology at the University of California-San Diego, and Dr. Kenshi Yamasaki of the Veterans Medical Research Foundation.

Dr. Gallo and Dr. Yamasaki will receive a $25,000 grant. In earlier studies, they discovered that individuals with rosacea have too much of a type of natural antibiotic called cathelicidins, and plan to use animal models and artificial cell culture techniques to further examine the function and activity of cathelicidin-processing enzymes in rosacea skin. If successful, the experiments may show that abnormal regulation of cathelicidin production leads to rosacea, leading to completely new therapeutic approaches.

Dr. Tristani-Firouzi and Dr. Samolitis were awarded $23,600 to examine the effect of pulse dye laser (PDL) and intense pulsed light (IPL) treatment of rosacea to determine whether, in addition to reducing the amount of blood vessels, these procedures produce structural and biologic changes in the skin.

Dr. Tristani-Firouzi and Dr. Samolitis will visually and microscopically assess the primary features of rosacea before and after treatment with PDL and IPL, including redness, visible blood vessels, and bumps and pimples. In addition, biopsy samples before and after treatment will be tested for factors that play a potential role in rosacea, including inflammatory cells, vascular endothelial growth factor (VEGF) and others.

They will also assess the size of the oil glands and the presence of Demodex mites, normal inhabitants of human skin that have been observed in greater numbers in rosacea patients. The study will include 10 patients with subtype 1 (erythematotelangiectatic) and subtype 2 (papulopustular) rosacea, each receiving treatment on one side of the face, with the other side serving as a control.

Experimental studies in the pathogenesis of rosacea.
Dr. Yaxian Zhen and Dr. Albert Kligman, department of dermatology, University of Pennsylvania.

Dr. Zhen and Dr. Kligman will receive $25,000 to develop objective, quantitative assessments of rosacea using a variety of equipment. They note that these noninvasive methods would provide a means to measure the presence and severity of rosacea's known symptoms, perhaps identify others, and gauge their presence and severity after treatment.

In an earlier study, Dr. Zhen and colleagues showed that rosacea shares many common features with acne, including increased sebum production and density of Demodex mites, as well as the presence of the bacterium Propionibacterium acnes.

Status: Declined.

Role of proteases and endothelin-converting enzyme in rosacea.
Dr. Martin Steinhoff, department of dermatology, University of Muenster, Germany.

Dr. Steinhoff and colleagues were awarded a $25,000 grant to test their hypothesis that a protein known as endothelin-converting enzyme-1 (ECE-1) may regulate vascular function and nerve-caused inflammation in the skin, and thus be involved in the pathophysiology of rosacea. The study aims to define the expression and distribution of the four ECE-1 isoforms in both normal and rosacea tissue, which may lead to new strategies to treat rosacea.

Dr. Mark Mannis and colleagues will receive $21,419 to study ocular rosacea. They note that despite its frequent appearance, ocular rosacea often does not receive attention from the medical community, and that the vision-threatening aspect of rosacea is virtually always associated with undiagnosed and untreated cases. They plan to look for abnormalities in the proteins and lipids present in the tear film of rosacea patients, and believe that significant differences between rosacea and normal patients might reveal a marker for the early diagnosis of ocular rosacea.

Molecular disease markers: gene expression profile of rosacea.Dr. Youwen Zhou, assistant professor of dermatology and director of the Chieng Genomics Center, University of British Columbia, Canada.

Dr. Youwen Zhou will receive $25,000 to expand on continuing NRS-funded investigation of gene expression profiles that so far have identified a difference in several genes between normal and rosacea-affected skin. The researchers hypothesize that patients with rosacea may express different levels of certain genes that may be involved in new blood vessel formation, inflammation and other signs and symptoms of the disorder.

Status: Interim report submitted. Study continues.

Role of proteases and PARS in rosacea.
Dr. Martin Steinhoff and Dr. Thomas Luger, department of dermatology, University of Muenster, Germany.

Dr. Martin Steinhoff and colleagues were awarded $25,000 to determine whether proteinase-activated receptor-4 (PAR-4) and its activators are expressed in different phases of rosacea; whether they modulate expression of vascular endothelial growth factor (VEGF), factors implicated in rosacea; and whether they stimulate the release of natural pro-inflammatory substances in cells that are implicated in the pathophysiology of rosacea, such as endothelial cells.

Biochemical and immunological characterization of the role of bacterial antigens in the induction of papulopustular rosacea.
Dr. Kevin Kavanagh, Department of biology, National University of Ireland, Maynooth, and Dr. Frank Powell, Consultant Dermatologist, Mater Misericordiae Hospital, Dublin.

Dr. Kevin Kavanagh was awarded $25,000 to pursue further research on the potential role of bacterial antigens in papulopustular (subtype 2) rosacea. In an earlier NRS-funded study, he and his colleagues succeeded in isolating a bacterium from Demodex folliculorum, microscopic mites that are a common inhabitant of facial skin. The bacteria produced antigens that induced an inflammatory response in significantly more rosacea patients than controls. In the new study, they will determine whether the presence of the antigens is predictive of the onset of rosacea, in order to establish whether they play a significant role.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, chief, division of dermatology, University of California San Diego, and scientific researcher Dr. Kenshi Yamasaki, Veterans Medical Research Foundation, San Diego.

Drs. Gallo and Yamasaki will receive $25,000 to study how cathelicidins, one of the body's own natural antibiotics, become active on the skin surface. The investigators earlier found that this type of antimicrobial peptide, which can cause inflammation and an increase in blood vessel growth, is abnormally high in rosacea patients. In a new study they will be investigating the causes of abnormal cathelicidin production and treatments that can correct this problem.

Dr. Granstein and colleagues will receive $25,000 to research how adenosine triphosphate (ATP), an agent their earlier studies showed initiates a response in human dermal microvascular endothelial cells, may promote rosacea. They hypothesize that ATP may contribute to local vascular and immune responses by acting on certain cell receptors, and they will also determine if ATP modifies other characteristics of endothelial cell biology relevant to inflammation.

Grants Awarded in 2004

The Society awarded $25,000 to Dr. Zhou and his colleagues to test their hypothesis that rosacea-affected skin may have characteristic gene expression profiles -- that is, patients with rosacea may express different levels of certain genes involved in new blood vessel formation, inflammation and other signs and symptoms of rosacea. The researchers will first identify the gene expression profiles of normal skin and skin from patients with subtype 1 rosacea (erythematotelangiectatic rosacea) and subtype 2 rosacea (papulopustular rosacea), respectively, by studying the RNA (genetic codes) from biopsy samples. They will then attempt to determine which metabolic pathways may be implicated in the pathogenesis (disease process) of rosacea.

Status: Interim report submitted. Study continues.

Role of proteinase-activated receptor-2 in the pathophysiology of cutaneous inflammation.
Dr. Martin Steinhoff and Dr. T. Luger, Department of Dermatology, University of Muenster, Germany.

Drs. Steinhoff and Luger were awarded $25,000 to investigate whether proteinase-activated receptor-2 (PAR-2) and its activators are differentially expressed during progressively more severe phases of rosacea; whether activators of PAR-2 modulate vascular endothelial growth factor (VEGF), which has been linked in earlier research to the development of telangiectasia, often seen in subtype 1 rosacea; and whether PAR-2 activators have an effect on the release of nitric oxide, a substance present in all cells that may be associated with erythema as well as inflammation.

Effects of neuropeptides and sebocyte-derived factors on human dermal microvascular endothelial cells of the skin: A possible mechanism for the development of vascular and inflammatory lesions of rosacea.
Dr. Richard Granstein, chairman, Department of Dermatology, Cornell University.

Dr. Granstein and colleagues were awarded $23,283 to continue research on how neuropeptides and hormones produced by nerves or cells in the skin may play a role in the flushing, telangiectasia and inflammation associated with rosacea. In their initial research, the researchers discovered that ultraviolet B (UVB) radiation found in sunlight may induce expression of VEGF as well as increase a cytokine that is associated with inflammation. Conversely, they found that a neuropeptide known as somatostatin appears to reduce production of VEGF. In the coming year, they will define how certain neuropeptides and hormones, alone or in combination with UVB irradiation, may affect the endothelial cells that line the blood vessels. This grant will also fund the study of UVB-irradiated keratinocytes (cells that produce keratin, a constituent of outer skin, hair and nails) and their effects on vascular endothelial cells, combined with the characterization of the effects of a number of neuropeptides on keratinocyte and endothelial activation.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, director of dermatology research, and scientific researcher Dr. Masamoto Murakami, Veterans Medical Research Foundation, San Diego.

$25,000 was awarded to Drs. Gallo and Murakami to further investigate the abnormal production in rosacea patients of cathelicidins, a type of protein made by the skin in response to injury or infection, a finding from an earlier Society-funded study (read the final report). The researchers will also investigate peptides that may help inhibit the disease process.

Experimental studies in the pathogenesis of rosacea.
Dr. YaXian Zhen, scientific researcher, and Dr. Albert Kligman, professor of dermatology, University of Pennsylvania.

The Society awarded Drs. Zhen and Kligman $25,000 to test the hypothesis that acne and rosacea may exist more commonly than is widely recognized, and that the two conditions may have certain features in common that may underlie their pathogenesis. The researchers observed that the faces of rosacea patients may produce more oil and may have subclinical microcomedones, enlarged oil glands and an increased number of the bacteria Propionibacterium acnes. They will study the facial skin of rosacea patients to determine sebum output, microcomedones and various microscopic aerobic and anaerobic organisms that may be associated with the disease process.

Grants Awarded in 2003

Effects of neuropeptides and sebocyte-derived factors on human dermal microvascular endothelial cells of the skin: A possible mechanism for the development of vascular and inflammatory lesions of rosacea.
Dr. Richard Granstein, chairman, Department of Dermatology, Cornell University.

Dr. Granstein was awarded $23,283 to study how neuropeptides and hormones, produced by nerves or cells in the skin, may play a role in the telangiectasia (visible blood vessels) and inflammation associated with rosacea. The researchers noted that many neuropeptides affect the diameter of blood vessels and can act in the skin. They will test cells that line tiny blood vessels in the skin. These cells will be exposed to either ultraviolet radiation or neuropeptides for the secretion of vascular endothelial growth factor (VEGF), which may be associated with the development of telangiectasia, as well as for cytokines and adhesion molecules, which may be responsible for the inflammation -- including papules (bumps) and pustules (pimples). Furthermore, they will test whether sebaceous cells (which produce oil in the skin) can be induced to produce factors that affect blood vessels.

Role of the innate immune system in rosacea.
Dr. Richard Gallo, director of dermatology research, and scientific researcher Dr. Masamoto Murakami, Veterans Medical Research Foundation, San Diego.

The Society awarded $25,000 to Drs. Gallo and Murakami to study whether cathelicidins -- proteins made by the skin in response to injury or infection -- will induce rosacea-like histopathological changes. This research expands on the results of their study last year, which demonstrated an association between these proteins and rosacea.

Dr. Roberts was awarded $20,000 to investigate the hypothesis that rosacea may be preceded by degenerative changes in the vascular and surrounding collegen and elastin tissue, that can lead to redness and telangiectasia. She plans to record microscopic findings -- correlated with clinical appearance -- in patients with subtype 1 (erythematotelangiectatic) rosacea before and after exposure to long-pulse 532-nm laser.

Status: Eligibility expired.

The role of bacterial antigen(s) in the etiology and persistence of papulopustular rosacea.
Dr. Kevin Kavanagh, Department of Biology, National University of Ireland, Maynooth, and Dr. Frank Powell, Consultant Dermatologist, Mater Misericordiae Hospital, Dublin.

The Society awarded $22,500 to Drs. Kavanagh and Powell to expand on an earlier study involving Demodex mites. They will examine whether these bacteria produce antigens that may cause papules and pustules in rosacea patients.

Symbiotic intraceullular bacteria of Demodex folliculorum and the pathogenesis of rosacea.
Drs. Richard Burroughs, Mark Peake and Richard Vinson, of William Beaumont Army Medical Center; Dr. Scott Norton, chief, Dermatology Service, Walter Reed Army Medical Center; and Dr. John Werren, professor of biology, and Seth Bordenstein, University of Rochester.

The researchers were awarded $12,250 to test Demodex from rosacea patients for the presence of bacteria, and analyze data for a possible statistical or clinical link between the bacteria and the presence of rosacea. They hypothesize that the cutaneous changes of rosacea may be due to an inflammatory response to bacteria within Demodex rather than the mite itself.

Status: Interim report submitted. Study continues.

Grants Awarded in 2002

Role of the innate immune system in rosacea.
Dr. Richard Gallo, associate professor of medicine/dermatology and pediatrics, University of California, San Diego; Dr. Takaaki Otake, postdoctoral fellow, Dermatology Research, Veterans Administration Medical Center of San Diego.

Drs. Gallo and Otake were awarded $25,000 to study whether a type of protein, cathelicidin, plays a role in rosacea. Cathelicidins are made by the skin in response to injury or infection. Although these proteins have been found to act as natural antibiotics, they may also cause inflammation and an increase in the growth of blood vessels. The study will investigate how cathelicidins are produced and act in rosacea patients, and whether they might also protect against rosacea-associated bacteria.

The Society awarded $22,430 to Dr. Thiboutot, Dr. Helm and Ms. Benjamin to investigate whether the physical characteristics of skin in rosacea patients differ from those of both normal subjects and those with other active inflammatory skin diseases in terms of sun damage, skin sensitivity, oiliness and expression of vascular endothelial growth factor (VEGF), which promotes telangiectasia.

The researchers were awarded $25,000 to study whether structural or functional abnormalities in blood vessels result in the redness, swelling, flushing and inflammation of rosacea. They will examine whether blood vessels of rosacea patients are more reactive to environmental influences than the skin of normal subjects, as well as whether capillary enlargement in rosacea patients is due to the fusion of several existing capillaries rather than the formation of new ones.

The Society awarded $2,200 for a study of the social effects of rosacea. They will administer a questionnaire assessing self-concept and role performance to rosacea patients and subjects without rosacea, then re-administer the survey to the rosacea patients after treatment to determine whether and how the disorder affects their self-perceptions in various situations and roles.

Grants Awarded in 2001

Dr. Lerner was awarded $25,000 to study the potential role of nitric oxide, a molecule produced by virtually all human cells, in causing rosacea. Nitric oxide can make blood vessels open more widely, causing skin to appear red, and can also lead to inflammation -- both signs of rosacea. He will study whether the enzyme that makes nitric oxide and the gene that produces this enzyme are elevated in rosacea patients.

An investigation of the role of bacterial and Demodex associated antigens in rosacea.
Dr. Kevin Kavanagh, Department of Biology, National University of Ireland, Maynooth and Dr. Frank Powell, Consultant Dermatologist, Mater Misericordiae Hospital, Dublin, Ireland.

The Society awarded $24,700 to Dr. Kavanagh to study whether bacteria associated with the Demodex mite may trigger the disorder directly by their presence or indirectly by stimulating the immune system.

The role of vascular endothelial growth factor in rosacea.
Dr. Mina Yaar, professor of Dermatology, Boston University Medical School.

Dr. Yaar was awarded $25,000 to continue her study to determine whether blood vessels in the affected areas of rosacea patients are more sensitive than those in unaffected areas to vascular endothelial growth factor (VEGF), which has a potent effect on blood vessels and may be associated with rosacea by abnormally increasing facial blood supply. Dr. Yaar will also study whether exposure to ultraviolet light, found in sunlight, leads to skin that has increased receptors for VEGF. In addition, she has found a molecule that may decrease VEGF production, and intends to determine whether this molecule may also block an increased sensitivity of the blood vessels to VEGF. In her ongoing study, Dr. Yaar found that VEGF was produced by skin cells of fair-skinned individuals prone to rosacea after exposure to ultraviolet light.

A grant of $22,330 was awarded to Drs. Fitzpatrick and Powell to document whether rosacea occurs more frequently in those with skin damaged by the sun, those with fair skin and those of Irish descent -- all frequently identified as potential rosacea risk factors.

Drs. Fitzpatrick and Powell are studying the frequency of inflammatory papulopustular rosacea in two Irish groups: hospital workers, expected to have little sun exposure because of their health knowledge and indoor occupation, and individuals from the Aran Islands off the west coast of Ireland, who as fishermen and farmers may experience extensive sun exposure.

The Society awarded $21,299 to Drs. Dahl and Schlievert to study whether the warmer skin of rosacea patients may play a role in causing the papules (bumps) and pustules (pimples) associated with rosacea. They noted that bacteria normally present on the skin, which produce a variety of toxins, may behave differently on the flushed and warmer skin of rosacea sufferers. Their aim is to grow bacteria taken from follicles on the skin of a rosacea patient at both high and low temperatures, and determine the amounts and composition of the toxins at each temperature range.

The role of vascular endothelial growth factor in rosacea development.
Dr. Mina Yaar, professor of Dermatology, Boston University School of Medicine.

A grant of $24,500 was awarded to Dr. Yaar to study whether a natural substance known as vascular endothelial growth factor (VEGF), which has a potent effect on blood vessels, may be associated with the development of rosacea by abnormally affecting facial blood supply. She noted that secretion of VEGF is induced after ultraviolet light irradiation such as exposure to the sun, which is frequently reported to trigger rosacea flare-ups, and that a molecule might be designed to prevent the release of this substance.

Endoglin expression in dermal endothelial cells.
Dr. Robert A. Swerlick, associate professor of Dermatology, Emory University School of Medicine.

A grant of $25,000 was awarded to Dr. Swerlick to study a possible cause of the telangiectasia (visible dilated blood vessels) that are a common symptom of rosacea. Dr. Swerlick pointed out that telangiectasia in individuals with a disorder called hereditary hemorrhagic telangiectasia are caused by decreased expression of the endoglin gene. He is studying whether exposure to such environmental factors as sunlight and heat, often reported as rosacea triggers, may likewise block this gene to allow formation of enlarged blood vessels in rosacea sufferers.

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The National Rosacea Society is a 501(c)(3) nonprofit organization whose mission is to improve the lives of people with rosacea by raising awareness, providing public health information and supporting medical research on this widespread but little-known disorder. The information the Society provides should not be considered medical advice, nor is it intended to replace

consultation with a qualified physician. The Society does not evaluate, endorse or recommend any particular medications, products, equipment or treatments. Rosacea may vary substantially from one patient to another, and treatment must be tailored by a physician for each individual case. For more information, visit About Us.